Tissue sealing electrosurgery device and methods of sealing tissue

ABSTRACT

An electrosurgery medical device is enhanced with unique solution-assistance, and comprises, in combination, co-operating device jaws including jaw portions for manipulating tissue, and a plurality of solution infusion openings defined and spaced along each of the jaw portions, for receiving electrolytic solution and infusing the solution onto and into tissue to be manipulated, along said jaw portions. As preferred, the device further comprises at least one, and most preferably, many, longitudinal groove(s) along at least one and most preferably, both, of the jaw portions, with the solution infusion openings located in the groove or grooves. The solution is energized with RF energy and contributes to the functions and beneficial effects of the instrument. The solution exits the openings in the grooves at sufficient flow rates to separate substantially all the operative surfaces of the device from tissue, thereby substantially completely preventing adherence between the operative surfaces and tissue. The solution is further energized to a range of energy densities such that tissues to be affected are sealed against flow of blood, lymphatic fluids, air, and other bodily fluids and gases.

BACKGROUND OF THE INVENTION

[0001] This invention relates to medical instruments, and moreparticularly to electrosurgical devices, and methods of manipulatingtissue as, for example, by cutting the tissue.

DESCRIPTION OF THE RELATED ART

[0002] High-frequency alternating current was used to cut and coagulatehuman tissue as early as 1911. Current generators and electrode tippedinstruments then progressed such that electrosurgical instruments andcurrent generators are available in a multitude of configurations forboth open procedures and endoscopic procedures, withmicroprocessor-controlled currents typically on the order of 500 KHz.Radiofrequency (RF) catheter ablation of brain lesions began in the1960s, and RF ablation of heart tissue to control supraventriculartachyarrhythmias began in the 1980s. Thus, electrical energy, includingbut not limited to RF energy, is a known tool for a variety of effectson human tissue, including cutting, coagulating, and ablative necrosis,with and as a part of electrically conductive forceps. Bipolar andmonopolar currents are both used with electrosurgical forceps. Withmonopolar current, a grounding pad is placed under the patient. A recentexample of an electrically energized electrosurgical device is disclosedin U.S. Pat. No. 5,403,312 issued on Apr. 4, 1995 to Yates et al., andthe disclosure is incorporated by reference.

SUMMARY OF THE INVENTION

[0003] An object of the present invention is to provide anelectrosurgery tissue sealing medical device which may and also may notbe a forceps.

[0004] Another object of the present invention is to provide anelectrosurgery tissue sealing device such as a forceps that seals tissueby a unique flow of an electrolytic fluid or solution to themanipulating portions of the device in combination with energization ofthe solution with electrical energy. The effect of the solution andenergy may be enhanced with pressure. The solution is brought intocontact with and infuses the tissue. The solution may include saline aswell as other non-toxic and toxic electrolytic solutions, and may beenergized with RF electrical energy. The body of the device itself mayor not be energized.

[0005] The solution provides at least in part the beneficial functionsand effects of the instrument. As preferred, pressure on the tissue isapplied, and most preferably the effect of pressure is optimized, as byapplying pressure across the tissue to be effected that is substantiallyuniform.

[0006] Another object of the invention is to provide an electrosurgerymedical device as described, and methods of sealing tissue, in whichtissues are sealed against flow of fluids including air. With theinvention, for example, lung tissue is aerostatically and hemostaticallysealed, with the tissue adjacent the sealed tissue retaining blood andair.

[0007] Another object of the invention is to provide an electrosurgerymedical device that may take the form of open surgery forceps of avariety of specific forms, or endoscopic forceps, also of a variety offorms.

[0008] A further object of the invention is to provide an electrosurgerymedical device as described, in which the electrolytic solution by whichthe instrument functions is infused from the device onto and/or into thetissue along the operative portions of the device. With and withoutapplied pressure, the solution coagulates and additionally sealstissue,, as a result of being energized by RF energy, and also envelopesthe operative portions of the device in solution all during manipulationof tissue, substantially completely preventing adherence between theinstrument and tissue, substantially without flushing action.

[0009] In a principal aspect, then, the invention takes the form of anenhanced solution-assisted electrosurgery medical device comprising, incombination, cooperating device jaws including jaw portions formanipulating tissue, and a plurality of solution infusion openingsdefined and spaced along each of the jaw portions, for receivingsolution and infusing solution onto and into the tissue along said jawportions. While the device is contemplated with and without grooves, aspreferred, the device further comprises at least one, and mostpreferably, many, longitudinal grooves along at least one and mostpreferably, both, of the jaw portions. Also most preferably, thesolution infusion openings are located on the inside faces of the jawportions, adjacent to and most preferably in the groove or grooves. Thesolution exiting the openings separates substantially all the operativesurfaces of the device from tissue, substantially completely preventingadherence between the operative surfaces and tissue. The solution alsoaids in coagulation.

[0010] Coagulation aside, the invention causes hemostasis, aerostasis,and more generally, “omnistasis” of substantially any and all liquidsand gases found- in tissue being treated, such as lymphatic fluids andmethane, as well as blood and air. These broader effects are understoodto result from such actions as shrinkage of vascalature with and withoutcoagulation, and without desiccation and carbonization.

[0011] Also as preferred, the operative portions of the device may takethe form of a circular, semicircular or other regular and irregulargeometric shape, to contain and/or isolate tissue to be affected andperhaps resected. As an example, with an enclosed geometric shape suchas a circle, tissue surrounding lesions and/or tumors of the lung may beaerostatically and hemostatically sealed, resulting in an isolation ofthe lesions and/or tumors for resection. Lung function is retained. Foradaption to unique tissue geometries, the operative portions of thedevice may be malleable, to be manipulated to substantially any neededcontour. For procedures including resection, the device may include anadvanceable and retractable blade, or additional functional structuresand features.

[0012] These and other objects, advantages and features of the inventionwill become more apparent upon a reading of the detailed description ofpreferred embodiments of the invention, which follows, and reference tothe drawing which accompanies this description.

BRIEF DESCRIPTION OF THE DRAWING

[0013] The accompanying drawing includes a variety of figures. Likenumbers refer to like parts throughout the drawing. In the drawing:

[0014]FIG. 1 is a schematic diagram of the key elements of an electricalcircuit according to the invention;

[0015]FIG. 2 is a perspective view of an endoscopic forceps according tothe invention;

[0016]FIG. 3 is a detail view of a portion of the forceps of FIG. 2; and

[0017]FIG. 4 is a perspective view of a modification of the embodimentof FIG. 2;

[0018]FIG. 5 is a second modification, of the embodiment of FIG. 4,shown partially broken away;

[0019]FIG. 6 is a perspective view of an open surgery forceps accordingto the invention;

[0020]FIG. 7 is a detail view of a portion of the forceps of FIG. 6,partially broken away;

[0021]FIG. 8 is a schematic view of preferred saline supply equipmentfor the invention;

[0022]FIG. 9 is a perspective view of a portion of the jaws of analternative device;

[0023]FIG. 10 is a perspective view similar to FIG. 9 of anotheralternative device;

[0024]FIG. 11 is a cross-sectional view along line 11-11 of FIG. 9; and

[0025]FIG. 12 is a perspective view of yet another alternative device.

DESCRIPTION OF THE PREFERRED ENDOWMENTS

[0026] Electrosurgery uses electrical energy to heat tissue and cause avariety of effects such as cutting, coagulation and ablative necrosis.The heat arises as the energy dissipates in the resistance of thetissue. The effect is dependent on both temperature and time. Lowertemperatures for longer times often yield the same effect as highertemperatures for shorter times. Normal body temperature is approximately37° C. No significant long-term effect is caused by temperatures in therange of37° C. to 40° C. In the range of 41° C. to 44° C., cell damageis reversible for exposure times less than several hours. In the rangeof 45° C. to 49° C., cell damage becomes irreversible at increasinglyshort intervals. The following table states expected effects at highertemperatures: Temperature (° C.) Effect 50-69 Irreversible cell damage -ablation necrosis.  70 Threshold temperature for shrinkage of tissue.(Some collagen hydrogen bonds break at 60-68; those with cross-linkagesbreak at 75-80.) 70-99 Range of coagulation. Hemostasis due to shrinkageof blood vessels. 100 Water boils. 100-200 Desiccation as fluid isvaporized. Dependent on the length of time during which heat is applied,carbonization may occur, and at higher temperatures, occurs quickly.

[0027] This table is not intended as a statement of scientificallyprecise ranges above and below which no similar effects will be found,and instead, is intended as a statement of generally accepted valueswhich provide approximations of the ranges of the stated effects.Limitation of the appended claims in accordance with this and thefurther details of this description is intended to the extent suchdetails are incorporated in the claims, and not otherwise.

[0028] As a consequence of the foregoing effects, preferred “soft”coagulation occurs at temperatures slightly above 70° C. Heat denaturesand shrinks tissues and blood vessels, thereby leading, as desired, tocontrol of bleeding. Cells are generally not ruptured. “Soft”coagulation is generally assured with voltages below 200 peak Volts.

[0029] Sparks are avoided. “Forced” coagulation can be accomplished withbursts of electrical energy. Electric arcs are generated. Deepercoagulation is achieved, at the cost of some carbonization and anoccasional cutting effect. Spray coagulation is also possible. Tissuecutting occurs by desiccation, when the concentration of electricalenergy, also referred to here as energy density, is acute, and thetemperature of tissue is raised above 100° C.

[0030] For both coagulation and cutting by electrical energy, a sinewave waveform is employed, with a frequency of about 500 kHz. Forcutting, increasing voltage to as much as 600 peak Volts leads to higherspark intensity which results in deeper cuts. Frequencies above 300,000Hz avoid stimulating nerve and muscle cells, and generally assure thatthe effect on tissue is substantially purely thermal.

[0031] In contrast with the RF energy tissue-cutting electrosurgerytools of the past, significant purposes of the present invention are toprovide a mechanism of avoiding desiccation of tissue at theelectrode/tissue interface and to achieve sealing of tissues. By“sealing,” the effects of hemostasis, or arresting of bleeding;“aerostasis,” or arresting of the passage of air; and closure of tissuessuch as blood vessels against larger-scale passage of blood, among othereffects, are intended. More specifically, the effect of sealing at thecellular level is a primary focus, as is sealing at the vascular level.

[0032] Referring to FIG. 1, key elements of a preferred electricalcircuit according to the invention include an electrosurgical unit 10, aswitch 12, and electrodes 14, 16. An effect is created on tissue 18 of abody 20. One electrode such as electrode 14 acts as a positive or activeelectrode, while the other such as electrode 16 acts as a negative orreturn electrode. Current flows directly from one electrode to the otherprimarily through only the tissue, as shown by arrows 22, 24, 26, 28,29. No pad is needed under the patient. This is a bipolar configuration.

[0033] Referring to FIG. 2, a forceps 30 according to the invention isan endoscopic forceps, and includes manual handles 32, 34, an elongatedshaft 36, and jaws 38, 40. The handles 32, 34 pivot together and apartand through a suitable mechanism (not shown; present in the incorporatedprior art) control the jaws 38, 40 to also pivot together and apartabout a pivot connection 42. Referring to FIG. 3, each jaw 38, 40 isformed in two parts, hinged together. The jaw 38 includes a link portion44 connected directly to the forceps shaft 36, and the jaw 40 includes alink portion 46 also connected directly to the forceps shaft 36. A jawportion 48 hingedly fastened to the jaw link portion 44 completes thejaw 38; a jaw portion 50 hingedly fastened to the jaw link portion 46completes the jaw 40.

[0034] As stated in the background of the invention, a wide variety ofalternatives to the structure described and shown in FIG. 2 arepossible. Prominent examples from those incorporated include thestructures of U.S. Pat. No. 5,403,312 (Yates et al.) issued Apr. 4,1995; U.S. Pat. No. 5,395,312 (Desai) issued Mar. 7, 1995; and U.S. Pat.No. 5,318,589 (Lichtman et al.) issued Jun. 7, 1994

[0035] Still referring to FIG. 3, a solution supply tube 52 supplieselectrolytic solution to an electrode strip 47 along the jaw portion 48,as will be described. A solution supply tube 54 supplies electrolyticsolution to a similar strip 49 along the jaw portion 50. A wire 56electrically connects to the solution supply tube 52; a wire 58electrically connects to the solution supply tube 54. All the supplies52, 54, 56, 58, both solution and electrical, extend from the proximalor manual handle end of the shaft 36, and connect to solution andelectrical sources.

[0036] Referring to FIG. 4, and in a second form of a jaw, designated140, a jaw portion 150 similar to jaw portion 50 in FIG. 3, includes alongitudinal dimension in the direction of arrow 160. A plurality oflongitudinal grooves 162 are spaced side-by-side across the inner face164 of the jaw portion 150. The grooves 162 extend the full longitudinallength of the jaw portion 150. The same is true of a mirror image jawportion, not shown. Both jaw portions are incorporated in a structure asin FIG. 3, and could be placed in substitution for jaw portions 48, 50in FIG. 3. Grooves, not shown, also preferably extend along thecorresponding jaw portions 48, 50 of FIGS. 2-3. Orientations of thegrooves other than longitudinal are considered possible, within thelimit of construction and arrangement to substantially retain solutionalong the operative jaw portions.

[0037] Bodily tissues to be manipulated have a natural surfaceroughness. This roughness significantly reduces the area of contactbetween the forceps jaws and manipulated tissues. Air gaps are createdbetween conventional smooth-surfaced jaws and tissues. If the jaws wereenergized when dry, electrical resistance in the tissues would beincreased, and the current density and tissue temperature would beextremely high. In practice, tissue surfaces are sometimes wet in spots,and yet tissue wetness is not controlled, such that electrical power isto be set on the assumption the inner jaw surfaces are dry. Thisassumption is necessary to minimize unwanted arcing, charring and smoke.

[0038] In contrast, in a forceps according to the invention, whether thejaw portions are grooved or smooth, whether the grooves are longitudinalor otherwise oriented, the jaw portions are uniquely formed of amaterial such as hollow stainless steel needle tubing such that solutioninfusion openings 166 may be and are formed in the jaw inner faces suchas the inner face 164, as in FIG. 4. Further, the solution supplies 52,54 shown by example in FIG. 3 may and do open into the openings 166, tosupply solution to the openings 166. As most preferred, the openings 166are laser drilled, and have a diameter in a range centered around fourthousandths (0.004) of an inch, and most preferably in a range from twoto six thousandths (0.002-0.006) inches.

[0039] The purpose of the openings 166 is to infuse solution onto and/orinto the tissue adjacent to and otherwise in contact with the forcepsjaw portions inner surfaces. It is understood the openings areappropriately as small in diameter as described above to assure moreeven flow among the openings than would otherwise occur. Further, theopenings need not be so closely spaced as to mimic the surface roughnessas tissues. Microporous surfaces are possibly acceptable, while they arealso not necessary. Infusion of fluid through the jaws is to bemaintained in a continuous flow during and throughout the application ofRF energy in order for the desired tissue effect to be achieved.

[0040] With the described structure and similar structures and methodswithin the scope of the invention, numerous advantages are obtained.Deeper and quicker coagulation is possible. The conductive solutioninfused onto and into the tissues maintains relatively consistentmaximal electrical contact areas, substantially preventing hot spots andallowing higher power than soft coagulation. Little to no arcing,cutting smoke or char is formed. Jaw and tissue surface temperatures arelower than otherwise, resulting in significantly less adhesion of tissueto jaw surfaces, and substantially no desiccation. One mode ofcoagulation may be used in the place of the three modes soft, forced,and spray. Coagulation is possible of even the most challenging oozingtissues such as lung, liver and spleen tissues. Coagulation is moreprecise, where other coagulation modes sometimes spark to the sides andproduce coagulation where not desired.

[0041] Also, and importantly, electrosurgical cutting by desiccation maybe avoided, and tissue sealing achieved. As desired, tissue sealing mayoccur alone, or be accompanied with mechanical cutting, as by aretractable and advancable blade as in U.S. Pat. No. 5,458,598, and aswith blade 1210 in FIG. 12, or otherwise. The tissue sealing itself isunderstood to occur by flow of electrolytic solution to the manipulatingportions of the forceps in combination with energization of the solutionwith electrical energy, and when included, in combination with pressureon, or compression of, the tissue. Compression of tissue is understoodto deform tissues into conditions of sealing of tissues and especiallyvascalature. Compression of tissue followed by application of solutionand energy is understood to permanently maintain compressed deformationof tissue, when present, and to shrink tissue and cause proteins to fixin place. Additional understanding of others is provided in the Yates etal. patent referenced above.

[0042] The body of the forceps itself may or not be energized. As mostpreferred, the solution primarily provides the beneficial functions andeffects of the instrument. The effectiveness and extent of the tissuesealing is a unction primarily of the type of tissue being manipulated,the quantity of electrolytic solution supplied to the tissue, and thepower of the electrical energy supplied to the solution. Tissues notpreviously considered to be suitable for manipulation, as by cutting,are rendered suitable for manipulation by being sealed against flow offluids, including bodily fluids and air. With the invention, forexample, lung tissue may be cut after sealing, with the tissue adjacentthe sealed tissue retaining blood and air. Examples of the principalparameters of specific uses of the invention are provided in thefollowing table. It is understood that the combined consequences of theparameters are that energy density in the tissue to be treated is in arange to effect sealing of the tissue. However, in general, a poweroutput of 7 to 150 watts is preferred. Fluid Quantity Power TissueEffect 2 cc’s per minute 20 watts for 30 1 cm diameter hemostasis perelectrode seconds vessel through the vessel 2 cc’s per minute 30 wattsfor 45 lung tissue hemostasis and per electrode seconds aerostasis 4cc’s per minute 40 watts for 90 2 cm thickness hemostasis per electrodeseconds liver tissue

[0043] In the examples for which the table is provided, the electrolyticsolution is saline. In the first example, the device in use was a deviceas in FIG. 2, with electrodes of 16 gauge tubing, 1 cm long. The tool inuse in the second and third examples was a forceps as in FIG. 6, withjaw portions 348, 350, to be described, 4 mm wide and 2.8 cm long. Nodesiccation was observed at the tissue/electrode interface. The deviceof FIG. 2 is preferred for vessel closure.

[0044] A wide variety of the currently installed electrosurgicalgenerators could and will provide proper waveforms and power levels fordriving the described forceps. The waveforms need only be sine waves atabout 500 kHz, and the power need only be about 30 or more watts. Asexample of available generators, Valleylab generators are acceptable andwidely available.

[0045] The electrolytic solution supplied to the forceps need only besaline, although a variety of non-toxic and toxic electrolytic solutionsare possible. Toxic fluids may be desirable when excising undesiredtissues, to prevent seeding during excision. Use of a pressure bulb ispossible, as shown in FIG. 8. A flexible reservoir such as anintravenous (IV) bag 410 is surrounded with a more rigid rubber bulb 412that is pressurized with air through an attached squeeze bulb 414. Thereservoir is filled with solution through an injection port 416. Anoutflow line 418 has a filter 420 and a capillary tube flow restrictor422 to meter flow. A clamp or valve 424 and connector 426 are alsoprovided. A typical flow rate is one to two (1-2) cc/min at a maximumpressure of approximately sixteen pounds per square inch (16 psi)(52mmHg). An example of opening diameters, numbers, and flow rate is asfollows: opening diameter, 0.16 mm; number of openings, 13 per cm; andflow rate, 2 cc's per minute. A long slit has also been used and foundacceptable. In this embodiment, flow rates of 0.01 to 50 cc/min arepreferred.

[0046] It is understood that highly significant to the invention is thespacing of a plurality of solution openings along the jaw innersurfaces. Single openings as in Ohta et al., that effectively pour fluidadjacent one portion of forceps, are generally not considered suitableor effective. Openings along outer surfaces of the jaws, opposite innersurfaces, are also generally not considered suitable or effective.

[0047] Referring to FIGS. 4 and 5, the configurations of the mostpreferred solution openings are disclosed. Referring to FIG. 5, in a jaw240, longitudinally spaced openings 166 are rotated from those shown inFIG. 4, in a jaw portion 250, to turn the openings away from most directcontact with tissues, and more carefully eliminate any unintendedplugging of the openings. Electrical insulators 268 in the form ofelongated strips extend alongside the tubes which include the openings166.

[0048] Referring to FIG. 6, open surgical forceps 330 include jaws 338,340 with jaw portions 348, 350. As with jaw portion 350 in FIG. 7, thejaw portions 348, 350 include spaced solution infusion openings 166 inthe central longitudinal groove of a plurality of grooves 162. A centralchannel 370 of both jaw portions 348, 350, as shown relative to jawportion 350 in FIG. 7, supplies solution to the openings 166 fromsolution supplies 52, 54. As with the endoscopic forceps of FIGS. 2-5,the open surgical forceps 330 benefits from the unique enhancement ofelectrosurgical functions through the infusion of electrolytic solutionsonto and into tissues through the spaced, laser drilled, solutioninfusion openings in the grooves 162.

[0049] Referring to FIGS. 9 and 10, open surgical devices 430 and 530also include jaws 438, 440 and 538, 540, respectively. The jaw portionsof these devices are curved, and in the case of device 430, circular, toadapt the invention to specialized surgical situations of tissuemanipulation, such as those in which fluid flow is to be terminated allaround a tissue to be isolated and resected or excised. An example ofsuch a tissue is a lesion or tumor of lung tissue. In endoscopic or opensurgery, such lesions or tumors may be encircled and/or isolated,surrounding tissue sealed, and the lesions or tumors thereafterresected. Preferably, a one centimeter margin is resected about anylesion or tumor, with the lesion or tumor. As shown, the devices 430,530 are formed of substantially square cross-section tubing, best shownin the cross-sectional drawing of FIG. 11. As most preferred, the tubingincorporates a central, depressed, cross-sectionally rectangular, andelongated groove 462 and equilaterally spaced, cross-sectionallytriangular, parallel, and elongated outer grooves 464, 465.

[0050] Laser drilled openings 466, similar to openings 166 describedabove, are located in and spaced along the central groove 462.

[0051] Alternate cross-sectional shapes of tubing may be employed, asexemplified in FIG. 12. Flatter operative, e.g., inner faces of tubingare preferred within limits of constructing and arranging the operativefaces to facilitate firm grasping and holding of tissue. Non-operativesurfaces, being less of concern, may adapt to a variety of contours fora variety of alternate reasons. Further, malleable tubing may beemployed, to permit the surgeon to shape the operative portions of theinvented devices to specific physiological situations.

[0052] The infusion of conductive solutions, referred to here also aselectrolytic solutions, simultaneously with the application of RF energyto tissues is discussed in further detail in U.S. Pat. No. 5,431,649entitled “Method and Apparatus for R-F Ablation,” in the name of PeterM. J. Mulier and Michael F. Hoey; in U.S. Pat. No. 5,609,151, entitled“Method and Apparatus for R-F Ablation,” in the name of Peter M. J.Mulier. The foregoing patents are commonly assigned to the assignee ofthe present invention, and are incorporated by reference here.

[0053] The preferred embodiments, and the processes of making and usingthem, are now considered to be described in such fill, clear, conciseand exact terms as to enable a person of skill in the art to make anduse the same. Those skilled in the art will recognize that the preferredembodiments may be altered and modified without departing from the truespirit and scope of the invention as defined in the appended claims. Forexample, if the invented device is incorporated in forceps, the forcepsmay be varied in a range from excision and cutting biopsy forceps, toendoscopic forceps, dissecting forceps, and traumatic, atraumatic andflexible endoscopic grasping forceps. The jaws may close into full andtight contact with each other, or close into spaced relationship to eachother, to accommodate tissue for purposes other than cutting. Asexpressed above, parallel spaced relationship is considered mostpreferably for uniformity of application of pressure across tissue to beaffected.

[0054] A variety of features such as jaw serrations, single acting anddouble acting jaws, closing springs, ratchet locks, fingertip rotationrings, color coding and smoke aspiration may or may not be included withthe features described in detail. Devices according to the invention maybe constructed and arranged to grasp, hold, fix, cut, dissect, expose,remove, extract, retrieve, and otherwise manipulate and treat organs,tissues, tissue masses, and objects. Endoscopic forceps according to theinvention may be designed to be used through a trocar. Bipolar andmonopolar currents may both be used. With monopolar current, groundingpads may be placed under patients. The described grooves may beeliminated in favor of alternative grooves.

[0055] For purposes of the appended claims, the term “manipulate”includes the described functions of grasping, holding, fixing, cutting,dissecting, exposing, removing, extracting, retrieving, coagulating,ablating and otherwise manipulating or similarly treating organs,tissues, tissue masses, and objects. Also for purposes of the appendedclaims, the term “tissue” includes organs, tissues, tissue masses, andobjects. Further for purposes of the appended claims, the term“electrical energy sufficient to affect tissue” includes electricalenergy sufficient to raise tissue temperature to cause non-reversibleeffect on tissue as described above.

[0056] To particularly point out and distinctly claim the subject matterregarded as invention, the following claims conclude this specification.

We claim:
 1. An electrosurgical, tissue sealing medical device,comprising in combination: co-operating device jaws including jawportions for manipulating tissue; solution infusion openings definedalong the jaw portions, the solution infusion openings being constructedand arranged for receiving an electrically conductive solution andinfusing the solution through the openings and along the jaw portionsinto tissue manipulated by the jaw portions; and an electrical conductoroperatively associated with the device jaws for conducting electricalenergy to the electrically conductive solution in contact with themanipulated tissue, the solution being supplied in quantity and theelectrical energy being supplied in power such that energy density inthe tissue in contact with the solution is in a range that seals thetissue against substantial flow of fluids; whereby tissue many bemanipulated without desiccation of the tissue at the tissue/deviceinterface and with sealing of the tissue against substantial fluid flowfrom the tissue.
 2. An electrosurgical, tissue sealing medical device asin claim 1, the jaw portions including opposed inner faces, the solutioninfusion openings being a plurality of openings defined and spaced alongthe inner faces.
 3. An electrosurgical tissue sealing medical device asin claim 1, further comprising: at least one groove along at least oneof said jaw portions, the solution infusion openings in the at least onejaw portion having the at least one opening located adjacent the atleast one groove.
 4. An electrosurgical, tissue sealing medical deviceas in claim 1, further comprising: at least one groove along at leastone of the jaw portions, the solution infusion openings in the at leastone jaw portion having the at least one groove located in the at leastone groove.
 5. An electrosurgical tissue sealing medical device as inclaim 1, further comprising a plurality of grooves along the jawportions of the co-operating device jaws, the solution infusion openingslocated in the plurality of grooves.
 6. An electrosurgical, tissuesealing medical device as in claim 1 further comprising: serrations onat least one of the jaw portions.
 7. An eletrosurgical, tissue sealingmedical device as in claim 1 further comprising: a proximal manualhandle, a shaft extending from the handle to the jaws, whereby the jawsare distally located, and a mechanism connected to the handle and jawswhereby the proximal handle manipulates the distal jaws, for endoscopicuse of the device.
 8. An electrosurgical, tissue sealing medical deviceas in claim 1 further comprising: a pivot for pivoting movement of thejaws into contact with each other and away from contact with each other.9. An electrosurgical, tissue sealing medical device as in claim 8further comprising: a blade along at least one of said jaw portions, formechanically cutting tissue as the jaw portions are pivoted towardcontact with each other.
 10. An electrosurgical, tissue sealing medicaldevice as in claim 1, further comprising: said jaws including means forsubstantially uniformly compressing tissue being manipulated by the jawportions.
 11. An electrosurgical, tissue sealing medical device,comprising in combination: co-operating device jaws including jawportions for manipulating tissue; solution infusion openings definedalong the jaw portions, the solution infusion openings being constructedand arranged for receiving an electrically conductive solution andinfusing the solution through the openings and along the jaw portionsinto tissue manipulated by the jaw portions; and an electrical conductoroperatively associated with the device jaws for conducting electricalenergy to the electrically conductive solution in contact with themanipulated tissue, the solution being supplied in quantity and theelectrical energy being supplied in power such that energy density inthe tissue in contact with the solution is in a range that seals thetissue against substantial flow of air; whereby tissue many bemanipulated without desiccation of the tissue and with sealing of thetissue against substantial air flow from the tissue.
 12. Anelectrosurgical, tissue sealing medical device apparatus comprising incombination an electrosurgical, tissue sealing medical device havingco-operating device jaws including jaw portions for manipulating tissue,solution infusion openings defined along the jaw portions, the solutioninfusion openings being constructed and arranged for receiving anelectrically conductive solution and infusing the solution through theopenings and along the jaw portions into tissue manipulated by the jawportions, and an electrical conductor operatively associated with thedevice jaws for conducting electrical energy to the electricallyconductive solution in contact with the manipulated tissue; theapparatus further comprising a solution supply constructed and arrangedto supply solution to the solution infusion openings; and an electricalsupply to the solution of electrical energy; the solution being suppliedin quantity and the electrical energy being supplied in power such thatenergy density in the tissue in contact with the solution is in a rangethat seals the tissue against substantial flow of fluid.
 13. Anelectrosurgical, tissue sealing medical device, comprising incombination: co-operating device jaws including jaw portions formanipulating tissue, a plurality of longitudinal grooves along said jawportions; a pivot for pivoting movement of said jaws into contact witheach other and away from contact with each other; a plurality ofsolution infusion openings defined and spaced along each of the jawportions for manipulating tissue, said solution infusion openingslocated in said plurality of longitudinal grooves, for receivingsolution and infusing solution into the tissue along said jaw portions;a solution supply to said plurality of solution infusion openings, forsupplying solution at a rate in a range of 0.01 to 100 cc/min; anelectrical supply of electrical energy sufficient to affect tissue, tosaid solution supply; and an extended shaft connected to said jaws forendoscopic use of said device.
 14. A medical procedure of manipulatingtissue, comprising: infusing an electrolytic solution to tissue;supplying electrical energy to said solution and thereby said tissue;and supplying the solution in quantity and the electrical energy inpower sufficient to seal the tissue against fluid flow from the tissue.15. A medical procedure as in claim 14, wherein the electrolyticsolution is saline.
 16. A medical procedure as in claim 14, wherein thesolution is supplied in quantity and the electrical energy in powersufficient to seal the tissue against air flow from the tissue.
 17. Amedical procedure as in claim 14, wherein the solution is supplied at arate in the range of 0.01 to 100 cc/ms in;
 18. A medical procedure as inclaim 14 wherein the electrical energy is supplied at a power in therange of 1 to 200 watts.
 19. A medical procedure of manipulating thin,delicate tissue, such as connective tissue, using an enhancedsolution-assisted electrosurgical medical device, an electrolyticsolution source, and an electrical energy source, said device comprisingin combination co-operating device jaws including jaw portions formanipulating tissue, and a plurality of solution infusion openingsdefined and spaced along each of the jaw portions for manipulatingtissue, for receiving solution and infusing solution into the tissuealong said jaw portions, the medical procedure comprising: supplyingelectrolytic solution from the solution source to the solution infusionopenings of said jaw portions, thereby infusing solution into tissuealong the jaw portions; supplying electrical energy from the electricalenergy source sufficient to affect tissue to said solution; andmanipulating tissue with said jaw portions at least in part whilesolution is infused into tissue along said jaw portions and electricalenergy is supplied to said solution; whereby the manipulated tissue issealed against fluid flow from the tissue during manipulation.
 20. Amedical procedure of manipulating tissue as in claim 19, furthercomprising supplying electrical energy sufficient to affect tissue tosaid jaw portions.
 21. A medical procedure of manipulating tissue as inclaim 19, further comprising utilizing a device having jaws with jawportions having a longitudinal dimension in a range of 0 to 6 inches,and further comprising: supplying solution to said solution infusionopenings at a rate in a range of 0.01 to 100 cc/min.
 22. A method oftreating masses in the lungs, comprising: isolating the masses fromsurrounding healthy lung tissue by sealing lung tissue encircling eachmass.
 23. A method of treating masses in the lungs, as in claim 22, inwhich the sealed lung tissue is sealed into omnistasis.
 24. A method oftreating masses in the lungs, as in claim 22, further comprising:resecting the masses to remove the masses from the lung tissue.
 25. Amethod as in claim 22, the sealing of lung tissue being conductedthrough application of electrolytic solution energized by electricalenergy.
 26. A method as in claim 22, or claim 25, the sealing of lungtissue being conducted through application of compression to the tissue.27. A method of treating masses in the body, comprising: at leastpartially isolating the masses from surrounding healthy tissue bysealing tissue at least partially encircling each mass.
 28. A method oftreating masses in the body, as in claim 27, in which the sealed tissueis sealed into omnistasis.
 29. A method of treating masses in the body,as in claim 27, further comprising: resecting the masses to remove themasses from the body.
 30. A method as in claim 27, the sealing of tissuebeing conducted through application of electrolytic solution energizedby electrical energy.
 31. A method as in claim 27, or claim 30, thesealing of tissue being conducted through application of compression tothe tissue.